RNY Gastric Bypass Surgery Complications, Risks

Gastric bypass, referred to as Roux-en-Y, is a highly effective procedure for reducing morbidly obese patients with a 35 or higher body mass index (BMI). It also successfully improves obesity-related comorbidities like type 2 diabetes, cardiovascular disease, asthma, and sleep apnea.

Gastric Bypass Surgery Procedure

Undergoing gastric bypass weight loss surgery does carry a certain degree of risk, just as any surgery would. Fortunately, most dangers can be eliminated by following the pre-op diet and having a qualified bariatric surgeon.

The most common risks that occur include;

  • Nutrient deficiency
  • “Dumping syndrome”
  • Anastomotic stricture

The learning curve for gastric bypass operation is steeper than lap band and gastric sleeve. The risk of gastric bypass complications is lower at centers like Mexico Bariatric Center, which do hundreds of bariatric surgeries per year (SOURCE: WebMD and MBC Research Study).

Gastric Bypass Gone Wrong

The Roux-en-Y Gastric Bypass is a rather complex procedure requiring many small millimeter-sized incisions and attachments.

According to West Penn Allegheny Health System, the mortality rate for gastric bypass is less than .03% (or 1 in 300 patients). In the United States, nearly 4 to 5% of patients who undergo gastric bypass will experience some kind of a complication (about 1 in 20 patients).

Surgeons must have proper technique and precision to minimize unwanted outcomes. Sometimes, for example, the bariatric doctor may leave a large opening as they attach the intestine to the new stoma, causing too much food to ‘bypass through.’

Post-Operative Risks and Complications

RNY Gastric Bypass Surgery Complications, Risks

The potential problems associated with gastric bypass surgery can be categorized as moderate to severe, both short and long-term. Remember, it’s important to have a bariatric surgeon with enough surgical skill and experience to make the appropriate-sized connections.

Early Risks and Complications

Immediate issues arising after gastric bypass surgery are known as short-term complications. These short-term problems can be easier to detect with post-op tests and can be resolved quickly if you are still in the hospital/recovery.

Short-term complications after gastric bypass surgery may include;

  • Internal Bleeding
  • Adverse reactions to anesthesia or medications
  • Blood clots (Deep Vein Thrombosis and Pulmonary Embolus)
  • Collapsed lung or breathing problems
  • Leakage in your gastrointestinal system
  • Infection (bladder, skin, abdominal, wound, or urinary tract)
  • Heart attack
  • Stroke
  • Injury to the abdomen, internal organs, esophagus
  • Pneumonia

Late Risks and Complications

Long-term complications that arise after gastric bypass are different because they usually go unnoticed for at least a few weeks post-op – sometimes much longer. These can be potentially risky because the signs and symptoms of complications may not be obvious or visible. You must listen to your body and see your doctor before the problem escalates or becomes more serious.

Long-term risks and complications may include;

  • Bowel obstruction
  • Dumping syndrome, causing nausea, vomiting, and diarrhea
  • Gallstones
  • Abdominal Hernia
  • Allergic reactions
  • Chest pain
  • Constipation or diarrhea
  • Dehydration
  • Low blood sugar (hypoglycemia)
  • Malnutrition
  • Stomach perforation
  • Ulcers
  • Vomiting and nausea
  • Enlarged heart
  • Gastrointestinal inflammation or swelling
  • Shoulder pain
  • Stoma obstruction

Six Common Complications Explained

1. Gallstones

Gallstones will typically happen in as many in 33% of patients, according to the Cleveland Clinic. Gallstones are small stones of cholesterol that cause serious pain as they pass, inflammation of the gallbladder, and lead to gallbladder removal. The risk for them rapidly increases with fast, substantial weight loss. Gallstones can be prevented by taking bile salts as a supplement for up to six months following surgery.

2. Ulcers

Ulceration commonly forms on the gastric and jejunal sides of the gastrojejunal anastomosis. A marginal ulcer (MU) occurs in approximately 5% of RNY Gastric Bypass patients. The symptoms are often associated with pain, vomiting, nausea, food intolerance, and bleeding.

Complications, such as ulcers, can be managed endoscopically after gastrointestinal weight loss surgery. Smoking after gastric bypass leads to ulcers and perforations.

3. Hiatal Hernia (HH)

Hiatal Hernia (type IV) following Roux-en-Y bypass is very infrequent (~5%). Late-term hiatal herniation of the gastric pouch and alimentary limb (proximal roux limb) can cause small bowel obstruction. If HH becomes symptomatic, it needs to be taken care of surgically.

A hiatal hernia is opposite to an incisional hernia, which is external and protrudes through the abdominal wall. An incisional hernia is a possible occurrence in open bypass surgery.

The hiatus is the diaphragm opening or the muscle wall separating the chest cavity from the abdomen. The proper digestive process involves food moving through the esophagus through the hiatus and into the stomach. However, when a hiatal hernia occurs, the stomach bulges into the chest. There are two types of Hiatal Hernias: paraesophageal or sliding. In a paraesophageal hiatal hernia, a portion of the stomach squeezes through the hiatus. Most of the time, this kind of hernia has no symptoms and can potentially shut off the blood supply.

4. Internal Hernia (IH)

A protrusion of the intestine through a defect, known as internal herniation, may occur after any abdominal surgical procedure. One possible late complication of RNY gastric bypass is an internal hernia through one of the mesenteric defects. The incidence of internal hernia among RNY bypass patients is estimated between 0.9% and 4.5%.

IH can result in small bowel obstruction (SBO), ischemia, or infarction and often requires surgical re-intervention. In severe cases, IH can result in strangulation of the intestine, which can be fatal.

5. Distal Stomach

In classical RNY gastric bypass, the distal excluded stomach is not removed and is left in place (in situ). Several complication cases associated with the in-situ remnant stomach have been reported. In re-sectional gastric bypass, however, the distal stomach is removed.

6. Twisted Bowel

Twisting of the roux limb after gastric bypass is a very rare complication. It presents itself as nausea, vomiting, and abdominal pain. Normally, the surgeon’s error at the time of operation is causing the turning of the intestine and needs surgical intervention to correct it.

Six Common Side Effects Explained

Most of the side effects result from a patient’s diet. To avoid diarrhea, nausea, weakness, and vomiting side effects, patients should avoid these foods:

  • High-fat foods
  • High-sugar foods

1. Dumping Syndrome

One of the major unpleasant side effects, dumping syndrome or rapid gastric emptying, is common in patients after gastric bypass. Rapid gastric emptying occurs when sugary food moves too quickly from your stomach into your small bowel.

Dumping syndrome is caused by eating sweets or other simple carbohydrates, dairy products (in some people), and alcohol. In an attempt to dilute the sugar, the body will flood the intestines, which will cause dumping syndrome symptoms such as nausea, vomiting, diarrhea, weakness, anxiety,  flushing, etc.

Patients can minimize the occurrence by eating small meals and following dietary guidelines set by their physician/nutritionist. Dumping syndrome could be useful for patients to know about their diet as the body would signal the wrong foods and drinks.

2. Dehydration

Dehydration is common and a serious side effect of gastric bypass. Because your new stomach is only 4 ounces, patients must consume water daily. Patients will need to consume 64 ounces per day. Patients need to look out for nausea and vomiting.

3. Difficulty Swallowing

Patients who eat too quickly or by not chew their food enough can have problems swallowing. Avoid eating too fast.

4. Indigestion

Indigestion can typically result because of poor patient diet. By fixing their diet, patients can reverse indigestion.

5. Hair Loss

We typically lose 75 to 100 hair daily, but some patients will lose hair during rapid weight loss (sometimes in clumps that may be alarming but are purely hormonal). Once you are getting near your weight goal, hair loss will slow. Hair loss may or may not happen, but it usually isn’t something to worry about unless your physician is concerned about malnutrition. Typically, the hair will regrow once you’ve reached your weight loss goal.

If you’re worried about post-operative hair thinning, you can take supplements (purchased from a variety of shops, online and brick and mortar) to help combat the rate at which you lose hair:

  • Co-Enzyme Q/10: 25-50mg per day
  • Biotin: 300mcg per day
  • Flax Seed Oil: 1-2 grams per day, gel tabs, oil, or sprinkles
  • Zinc: 50mg per day

6. Nutrient Deficiency

Approximately 30% of gastric bypass patients will develop a nutritional deficiency such as metabolic bone disease, anemia (iron deficiency), or osteoporosis. These deficiencies can be avoided if the proper vitamins and minerals are consumed daily following surgery. According to the University of California –San Francisco, a gastric bypass patient should take the following vitamins or supplements:

  • A multivitamin that includes a minimum of 18 mg of iron, selenium, zinc, copper, and 400 mcg of folic acid. Take two of these daily for at least three months following surgery, and then just one daily.
  • Take 1,200 to 2,000 mg of calcium each day. To enhance the absorption chance, take two or three doses throughout the day.
  • Take 800-1,000 IUs of Vitamin D. Divide the dosage into two doses. Take it with the calcium supplement.
  • Take 500 mcg of Vitamin B.

Side Notes

Research studies show that patients after laparoscopic gastric bypass and mini-gastric bypass surgery should take high-protein food and drinks in combination with alcoholic drinks and exercise to avoid a low hemoglobin (Hgb) level. It’s also important that women avoid pregnancy for up to two years when their weight is stabilized. This is because rapid weight loss can lead to nutritional deficiencies that can harm a developing fetus and the chance of a successful pregnancy.

To reduce post-op deficiencies, all gastric bypass patients should consume nutritional supplements made according to ASMBS recommendations, such as Emerge Bariatrics Vitamins.

Guide to Gastric Bypass Surgery: